Chabot College Nursing Program Associate in Arts Degree - Enrollment Criteria Effective Fall 2015 Application Student Name: W#:

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1 Chabot College Nursing Program Associate in Arts Degree - Enrollment Criteria Effective Fall 2015 Application Student Name: W#: Section Description Max Points Section 1 Academic Degrees 5 Section 2 Health Care Experience 6 Section 3A Sciences Courses 40 Section 3A Repeated Sciences -2 Section 3B General Education Courses 7 Section 3C Statistics (Optional) 3 Section 4 Life Experience 2 Student Total Program Items Total of 40 students are selected one time each year in May for the next fall enrollment. Students will then be RANKED by Criterion Score*, if all required documentation including transcripts has been received. If the pool consists of several students earning the same Criterion Score those students will enter a random pool for RANKING. If not selected, students must reapply each year. We do not maintain a waitlist of students. *Criterion Score may be modified each year to meet the student and program standards. Section 5 Military 5 Please enter points earned, sign and submit first page and required, supporting documentation as needed with your application packet. Section 6 Second Language 2 Sub Total 70 Section 7 TEAS Score: 30 Total Points Earned 100 Student Signature PRINT Student Name Pages 2 through 4: Breakdown of Criterion Worksheet sections listed above. Page 5: ADN Documentation for section 4 and Language Proficiency. Page 6: Certification of Language Proficiency.

2 Chabot College Nursing Program ADN Criteria - Effective Fall 2015 Application SCORE CRITERIA POINT DISTRIBUTION REQUIRED SUPPORTING DOCUMENTATION 1. Previous academic degrees or diplomas (Maximum Points = 5) 1A. BS/BA or higher OR AA/AS Degree Official transcript from regionally accredited U.S. colleges or universities with 5 Check box for Degree BS/BA AA/AS degree posted. OR 1B. Foreign Degree equivalent to BS/BA All transcripts from outside the United States must be evaluated by a 1 degree CHABOT- approved foreign evaluation service. See counselor for listing. 2. Relevant health care license or certificate held by a student (Maximum Points = 6) OR 2A. License Health Care Worker (i.e. LVN, Paramedic, Psychiatric Technician, Radiologic Technician or Surgical Technician) Work* experience is required in direct patient care > 1000 hours within the last 18 months. *Work must be documented paid hours, not volunteer hours. 2B. Certificated Health Care Worker (i.e. Allied Health Certificate) Work* experience is required in direct patient care > 1000 hours within the last 18 months. 6 Check box for current license LVN Psych Tech Paramedic Radiologic Tech Surgical Tech with License 3 CNA MA Other 3. Grade point average in relevant course work (3A = 40 point Max + 3B = 10 points Max = Maximum Points = 50) 3A. Minimum 2.5 GPA in Science Prerequisites: Anatomy, Physiology, and Microbiology. Only one C grade allowed. No more than one withdrawal or repeat of any substandard grade in the above listed science prerequisites will be allowed. Students who have withdrawn or repeated any science prerequisite must deduct 2 points from their score. 40 Points Max GPA GPA GPA GPA GPA GPA GPA GPA GPA GPA Licensed healthcare worker: Attach a copy of your current picture ID California License, date of issue, and date of expiration. Work: Attach a letter from current/former employer verifying employment in a position under your current license. The letter must be on organization letterhead with an original signature and must include student s name, start date and end date (if applicable), employee status (full-time/part-time), number of hours worked per week (or total hours from/to date), job title, department, if applicable, and last paystub. Certificated healthcare worker attach a copy of your current California or National certificate including your certificate number, date of issue, and date of expiration. Work: Attach a letter from current/former employee verifying employment in a position under your current certificate. See 2A above for letter definition. Refer to for comprehensive Allied Health jobs titles Official transcripts (in original sealed/unopened envelope) for all lower and upper division courses completed at any and all regionally accredited U.S. institutions, regardless of applicability to nursing requirements will be required. Transcripts will not be required for courses completed at CHABOT or LAS POSITAS COLLEGES. All transcripts from outside the United States must be evaluated by a CHABOT-approved foreign evaluation service. Courses completed at other regionally accredited United States colleges or universities must be equivalent to Chabot College courses. See a counselor for guidance or _CriteriaChabotCollege_Final Edit: 10/10/2014 Page 2

3 Chabot College Nursing Program ADN Criteria - Effective Fall 2015 Application SCORE CRITERIA POINT DISTRIBUTION REQUIRED SUPPORTING DOCUMENTATION Section 3 continued 3B. Overall average GPA in FIXED courses English 1A C-ID ENG 100, Sociology 1 C-ID SOCI 110, Psychology 1 C-ID PSY 110, and Communications 1 or 10 C-ID COMM 110, 130 (C-ID Equivalent courses will be accepted.) 3C. Effective Fall 2015 (Optional not required) Statistics C-ID MATH 110 Withdrawal Repeat D/F -2-2 GPA GPA GPA GPA GPA Life experiences or special circumstances of a student (Maximum Points = 2 Points) 4A. Disabilities (Same meaning used in Section 2626 of the Unemployment Insurance Code) OR 4B. Low family income (Eligibility for, or receipt of, financial aid under a program that may include, but not limited to, a fee waiver from the Board of Governors, the Cal Grant Program, the federal Pell Grant program or CalWORKs) All prerequisite courses must be completed with a grade of C or better and the final grade must be posted on the transcript. For any course in which a grade of C or better was earned, the EARLIEST course grade will be utilized. Failure to submit transcripts with all grades posted will result in disqualification from the application process. Fixed Courses are courses required for an AA degree in nursing and are also required by the Board of Registered Nursing. Fall 2015 students will be required to complete these courses in addition to the science prerequisites listed in 3A. C or Better 3 This will ease transition to a BSN program after graduation. Course must meet CSUEB transfer standards. 2 Documented disability from college Learning Disability Program or Disability Support Programs & Services. Search for Unemployment Insurance Code Section Webpage: 2 Proof of eligibility or proof of receipt of financial aid (e.g. BOG fee waiver, Cal Grant, Pell Grant or other federal grant, CalWORKs). OR 4C. First generation to attend college 2 Complete the ADN Admission Supporting Documentation Form explaining situation or circumstances. OR 4D. Need to work (Need to work means student is working at least part-time while completing academic work that is prerequisite for the Nursing Program) Continued on next page 2 Paycheck stub during period of time enrolled in prerequisite courses or letter from employer (must be on organization letterhead) verifying employment was at least part-time while completing prerequisite courses. Students may work during the program but are strongly encouraged not to work or reduce their hours. 2015_CriteriaChabotCollege_Final Edit: 10/10/2014 Page 3

4 Chabot College Nursing Program ADN Criteria - Effective Fall 2015 Application SCORE CRITERIA POINT DISTRIBUTION REQUIRED SUPPORTING DOCUMENTATION OR 4E. Disadvantaged social or educational environment 2 Participation or eligibility for Extended Opportunity Programs & Services (EOPS), PUENTE, ASPIRE, EXCEL, or DARAJA. OR 4F. Difficult personal and family situation/circumstances 2 Complete ADN Admission Supporting Documentation Form explaining situation or circumstances. OR 4G. Refugee status 2 Documentation or letter from United States Citizens and Immigration Service (USCIS). 5. Military Service (Maximum Points = 5 Points) Veteran Status 5 Copy of Defense Department Form DD214. Honorable Discharge required. 6. Proficiency or advanced level coursework in languages other than English (Maximum Points = 2 Points) Proficiency (reading/writing/speaking) in a language other than English 2 Official transcript from a U.S. regionally accredited college or university verifying four (4) semesters of foreign language OR Verification of proficiency Complete the ADN Admission Supporting Documentation Form. TEAS Students are NOT required to take the test to apply. Students will be evaluated on all criteria (Steps 1-6) above and ranked for selection. Top Students will be asked to submit an original TEAS version V from ATI Testing or take the TEAS exam at Chabot College in May. Using the following scoring these students will then be ranked for selection. Top 40 students in point total will be selected and next will be alternates. 7. Approved diagnostic Assessment Tool (Maximum points = 30) 1. Test of Essential Academic Skills TEAS TEAS Score Version V offered through Assessment 98 to 100 Technologies Institute (ATI) to Only the first passing score will be counted 94.9 to 93 towards ranking to If student scores below 62% on their first 89.9 to 87 attempt, remediation is required before 86.9 to 84 retaking the test. The student is not 83.9 to 81 eligible for the Fall program and must 80.9 to 78 reapply to 75 Pts TEAS Score 74.9 to to to to 62 Pts If selected, an official copy must be sent directly to the Chabot Nursing Program for confirmation. To obtain an official copy, go to sign in and request a copy be sent to Chabot College.* *If tested through Chabot College, your test will be on file. You do NOT need to submit another copy. 2015_CriteriaChabotCollege_Final Edit: 10/10/2014 Page 4

5 Chabot College Nursing Program ADN Admission Supporting Documentation Form Student Name: Student ID # Last, First Name Section 4 Maximum Points earned = 2 points Attention Please PRINT Criteria 4C. First generation to attend college. Please briefly explain your situation or circumstances: OR Criteria 4E: Difficult personal and family situation/circumstances. Please briefly explain your situation/circumstances: Section 6 Maximum Points earned = 2 points Criteria 6: Verification of proficiency in a foreign language outside of college coursework. Please PRINT! I verify that I am proficient in Language (s) at a level that allows common everyday communication. I am proficient in (check all that apply) SPEAKING READING WRITING Please explain your level of proficiency and how you acquired this language. (50 words or less) Student s Acknowledgement I certify that all information I have provided is complete and accurate to the best of my knowledge. I understand that falsification of any information will result in my disqualification from candidacy or if selected, dismissal from the program. Student Signature Please use Blue INK for signature Date 2015_CriteriaChabotCollege_Final2015_CriteriaChabotCollege_Final 11/6/2014 9:33:12 AM

6 Chabot College Nursing Program ADN Admission Supporting Documentation Form CERTIFICATION OF LANGUAGE PROFICIENCY (Optional Form) To be submitted with the Nursing Application Instructions to the Student: This form is OPTIONAL and is not required to be considered for admission to the Nursing degree program. Part I: Enter your name below and follow the directions. Part II: Ask a member of your community (not your close family) to complete this section. PLEASE PRINT. Part I: STUDENT INFORMATION Student Name: Student ID #: W STUDENT CERTIFICATION OF PROFICIENCY LANGUAGE: Part II: THE PERSON COMPLETING THIS LANGUAGE PROFICIENCY CERTIFICATION English is 1 st Language or 2 nd Language A) Person must be fluent in the identified foreign language and B) Person must also have known the student and observed his/her language skills in the past year. Please complete the following: Name: Title: Address: City: Phone: Organization: ST/Zip: 1: How long have you known the student and in what capacity? 2: How often have you observed the student conversing/translating in this language? Daily 2 days/week 1 day/week Other: For each of the following statements, please rate the student on a scale from 1 (low) to 5 (high): 1 = inadequate second language proficiency for professional communication 3 = able to translate in a medical emergency 5 = highly competent in speaking and writing proficiency 3: Student's proficiency in speaking this language is: : Student's proficiency in writing this language is: Student's proficiency in reading this language is: x Signature (Section II) Date 2015_CriteriaChabotCollege_Final2015_CriteriaChabotCollege_Final 11/6/2014 9:33:12 AM